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Immunosuppressants key to successful ocular surface transplants
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SAN FRANCISCO — In patients whose conjunctiva is so severely damaged the eye warrants ocular surface transplantation, “systemic immunosuppression is the key to success,” said Edward J. Holland, MD. He spoke here during the annual meeting of the American Society of Cataract and Refractive Surgery.
Dr. Holland noted that ocular surface transplantation has “a 0% success rate if there’s true limbal deficiency.” Among the most common reasons patients require transplantation are chemical injuries and Stevens-Johnson syndrome. Currently, the most common source of donor tissue is either a living relative or cadaveric eyes, Dr. Holland said. Over a 15-year follow-up, the donor eyes of relatives that have given up to 50% of their limbus have had no visual repercussions, he said.
About 60% of the patients on whom Dr. Holland performs this procedure have severe glaucoma upon presentation, and managing intraocular pressure is critical, he said.
“We perform tube shunts early,” he said. “Topical glaucoma medications interfere with the corneal surface, and we need to reverse the lid abnormality immediately.”
Inflammation is the No. 1 reason transplantation fails, he said. Surgeons must put these patients on systemic immunosuppressants to give the transplant a chance of success, he stressed.
In the future, “expect to see more ex-vivo expanded limbal allografts,” Dr. Holland said. “This seems to be having a lot of success in Italy right now, but we’re not quite there yet.”